Abstract 5617: Paradoxical Low Use of Coronary Interventions in High-Risk Non-st Segment Acute Coronary Syndromes with Heart Failure. Data from the Oasis-5 Randomized Trial
Early angiography with a view to revascularization is widely recommended for patients with non-ST segment elevation Acute Coronary Syndromes (ACS) at high risk, such as heart failure (HF). Yet there are few data regarding its use and impact on outcomes. We used data from the large international OASIS-5 trial in high-risk non-ST ACS to analyse the use of interventions in this setting OASIS-5 was a randomized trial of fondaparinux vs enoxaparin in non-ST segment elevation ACS at high risk (defined by 2 of the following 3: an age of at least 60 years, an elevated level of troponin or creatine kinase MB isoenzyme, or electrocardiographic changes indicative of ischemia.) performed in 41 countries. We compared patients with Killip class II and III to Killip I patients. Shock patients were excluded. (Table⇓): Out of 20053 patients randomized and without shock, 8.6% had HF (Killip II or III) at entry in the trial. They had much higher risk baseline characteristics than patients without HF). Use of interventions (angiography, and PCI) was lower in patients with HF despite their much higher risk. 9-day and 180-day mortality were far worse in pts with HF than without (HR 4.24 [3.37–5.33] and HR 3.62 [3.18 – 4.14] respectively, p<0.0001 for both). 28.2% of the 9-day deaths in the whole trial occurred in the 8.6% of pts with HF. in this high-risk population, despite current recommendations, the use of coronary angiography and revascularization during the index hospital stay was low. Among the subset of patients with HF, who have an extremely high mortality, use of interventions was paradoxically lower. More frequent use of interventions in the subset with HF may substantially reduce the number of deaths.